“I am not only a nurse to them; I am a confidante. If I were not able to reach them, I would feel like I abandoned and betrayed them."
When President Trump re-enacted the Global Gag Rule in January 2017, the intention was to cut off pro-choice organisations like Marie Stopes International at the knees.
One of Trump’s first acts in office, the policy prohibits any international family planning organisation that supports safe abortion from receiving US Government funding – ignoring the fact that US money has never been spent on abortion services overseas.
Two years on, Marie Stopes International is facing a funding gap of $50 million through to 2020 as a direct result of the policy. Yet despite the devastating threat this poses to the world’s most vulnerable women and girls, the Global Gag Rule is inspiring a generation of women working in family planning to stand stronger than ever for those who depend on them.
In Zimbabwe, nurse Esther Chidumo works as part of a three-person outreach team that travels all over the country, providing free contraceptive services and advice to around 50 women and girls per day. For women in remote villages, the outreach service is a lifeline.
“Most [of the women we see] are taking contraception due to the economic hardships. Many of our clients have no money. In the towns, long-term methods are expensive, so when we provide the services for free in rural areas, they are very happy.”
The loss of US Government funding has already had a direct impact in Zimbabwe, where outreach teams like Esther’s have already had to halve the number of sites they visit from 1,200 to 600. In Esther’s eyes, further cuts would be disastrous.
“It means poverty will continue to increase because these women that we serve don’t have money to get these services and they don’t have the money to travel. For long-acting methods, they would have to go to the district hospitals, which is a very long journey for them and they don’t have the fares for the bus. So if these services are going to be withdrawn, it means these women will suffer.”
"Many of our clients have no money... If these services are going to be withdrawn, it means these women will suffer."
On the island nation of Madagascar, where the average income is less than $500 per year, nurse Annie Ramasy has also been grappling with the impact of the new policy. A voucher programme that delivered sexual and reproductive healthcare to thousands of women has already been forced to close, while 20 outreach teams like Annie's have also shutdown, leaving the future uncertain for many who rely on the programme for family planning.
“When I heard that [the US Government] had withdrawn their funding, I asked my clients how they would feel if we couldn’t come anymore. One of them screamed: De ahoana amin’izany? (So what now?).”
In Madagascar, a country where many women struggle to access any method of contraception, the arrival of Annie’s team in remote villages is often women’s only chance to prevent unwanted pregnancies and manage the size of their families. Annie has worked over many years to build relationships with her clients.
“When I started, we only had 10-15 people coming for services. Progressively I gained their trust by explaining how contraception works, and the number of clients has consistently increased. Today there are up to 40 clients waiting for me when I arrive.”
Being the only service provider the women know, Annie understands the vital role she plays in the community. Working under the threat of closure has only made her more committed to ensure women get the services they want and need.
“I am not only a nurse to them; I am a confidante. If I were not able to reach them, I would feel like I abandoned and betrayed them.
“Contraception does not only prevent pregnancies; it gives you the time to define what you want to do with your life. In a country like Madagascar, having a large family when you cannot afford it prevents thousands of people having the chance to get a better life. If you cannot move your family forward, how can you move your country forward?”
All over the 37 countries where Marie Stopes International works, we are seeing women, men and young people become even stronger advocates for choice as they witness the insidious effects of the Global Gag Rule in their communities. Both Esther and Annie are part of that movement, and they are ready to fight on.